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My mom is 81 and has had PD for approximately 17 years. She's lived with me for the past 5 1/2 years. She falls every couple of weeks, but seems to get away without too much damage except the last fall she broke her wrist and has been in a cast.

I was wondering what I need to expect in the next state of the disease. Currently she can eat most anything if I cut it up small enough. She still uses her walker to get around. She gets confused about dates and apts but seems to have it together other than that. She is incontinent. Her voice is very high pitched and whiny.

What can I expect next??

Parkinson's - What should I expect next??

My mom is 81 and has had PD for approximately 17 years. She's lived with me for the past 5 1/2 years. She falls every couple of weeks, but seems to get away without too much damage except the last fall she broke her wrist and has been in a cast.

I was wondering what I need to expect in the next state of the disease. Currently she can eat most anything if I cut it up small enough. She still uses her walker to get around. She gets confused about dates and apts but seems to have it together other than that. She is incontinent. Her voice is very high pitched and whiny.

Mama's progression of the disease was very much like your Mom. We didn't get an early diagnosis and I think her symptoms advanced rapidly. As the falls were becoming more frequent she began with freezing in place. She could not take a step. She eventually became totally wheelchair bound and the dementia advanced until she didn't know me. She talked about her daughter to me as if I were someone else. on the 4th of December, she aspirated some juice and everything we tried to give her for the next day, she also aspirated. I don't know what brought this on because the day before she ate her meals without a problem. She had been having some issues with choking but it sounded like anyone who chokes. On the fourth it was very different. She sounded like she was drowning. Her coughs were very "wet." I took her to the emergency room and within two days we learned she had aspiration pneumonia. Because she had a living will and didn't want a feeding tube, the hospital could do no more. We brought her home and she passed away on the 15th of this month. I'm so sad to be without her but PD is an ugly insidious thief of one's mind and body.

Mama's progression of the disease was very much like your Mom. We didn't get an early diagnosis and I think her symptoms advanced rapidly. As the falls were becoming more frequent she began with freezing in place. She could not take a step. She eventually became totally wheelchair bound and the dementia advanced until she didn't know me. She talked about her daughter to me as if I were someone else. on the 4th of December, she aspirated some juice and everything we tried to give her for the next day, she also aspirated. I don't know what brought this on because the day before she ate her meals without a problem. She had been having some issues with choking but it sounded like anyone who chokes. On the fourth it was very different. She sounded like she was drowning. Her coughs were very "wet." I took her to the emergency room and within two days we learned she had aspiration pneumonia. Because she had a living will and didn't want a feeding tube, the hospital could do no more. We brought her home and she passed away on the 15th of this month. I'm so sad to be without her but PD is an ugly insidious thief of one's mind and body.

Oh my gosh! I'm so sorry about your Mom. That's really scary. Mom does the choking thing too (or I call it strangling). She's always able to get ti under control by coughing for a little while. Seems to happen with meat. Even though I try to cut everything up real small, I'm thinking I may need to eliminate that all together. Mom gets confused sometimes about dates and appointments, but hasn't really shown any real signs of dementia (yet). I'm not sure if that always comes with PD or not. She does get confused about her medicine even though I lay it out for the day. I'm having to basically give her each dosage now instead of thinking she can take it herself. Mom still uses a walker, but falls one or twice a month. We have an electric wheelchair, but she can't figure out how to maneuver it so she just doesn't try. I'm very scared about what the future holds. I'm trying to get her into an adult daycare type program which would give me some time for myself during the day. It's so hard to not be able to leave my house unless my husband or someone else is here with Mom.

Again, so sorry to hear about your mom. You know she's in a better place.

Oh my gosh! I'm so sorry about your Mom. That's really scary. Mom does the choking thing too (or I call it strangling). She's always able to get ti under control by coughing for a little while. Seems to happen with meat. Even though I try to cut everything up real small, I'm thinking I may need to eliminate that all together. Mom gets confused sometimes about dates and appointments, but hasn't really shown any real signs of dementia (yet). I'm not sure if that always comes with PD or not. She does get confused about her medicine even though I lay it out for the day. I'm having to basically give her each dosage now instead of thinking she can take it herself. Mom still uses a walker, but falls one or twice a month. We have an electric wheelchair, but she can't figure out how to maneuver it so she just doesn't try. I'm very scared about what the future holds. I'm trying to get her into an adult daycare type program which would give me some time for myself during the day. It's so hard to not be able to leave my house unless my husband or someone else is here with Mom.

Again, so sorry to hear about your mom. You know she's in a better place.

Hi Gail,
My mom has PD and it seems like we have had to learn as we go. My mom has to have her food pureed and this has made eating so much easier for her and her caloric intake is much improved. She is able to feed herself (using a curved utensil) and that has given her more independence. She also has thickener in her fluids so she has less chance of aspirating on her fluids. She can drink soda because of the carbonation and its syrup based. Anyway, I hope that helps with some practical daily issues. I hope you pursue some kind of care for your mom so you can have time to take care of yourself. God bless you for caring so wonderfully for you mom. Jenny

Hi Gail,
My mom has PD and it seems like we have had to learn as we go. My mom has to have her food pureed and this has made eating so much easier for her and her caloric intake is much improved. She is able to feed herself (using a curved utensil) and that has given her more independence. She also has thickener in her fluids so she has less chance of aspirating on her fluids. She can drink soda because of the carbonation and its syrup based. Anyway, I hope that helps with some practical daily issues. I hope you pursue some kind of care for your mom so you can have time to take care of yourself. God bless you for caring so wonderfully for you mom. Jenny

Thanks for the information Jenny! Yep, it's definitely a learn-as-you-go process! I'm not sure we're at the puree stage yet, but it's probably not too far down the road.

Since she broker her arm (she no longer has her cast) she seems to be almost 100% dependent on me for almost everything. I'm not sure why that is, because she's perfectly able to do most everything for herself. I wish she would understand that the longer she's able to take care of herself, the longer I'll be able to keep her with me. The more dependent she gets and the more demanding her care gets, I'll have to consider a nursing home where someone can be there 24/7 for her. I just don't want that to happen.

Thanks for the information Jenny! Yep, it's definitely a learn-as-you-go process! I'm not sure we're at the puree stage yet, but it's probably not too far down the road.

Since she broker her arm (she no longer has her cast) she seems to be almost 100% dependent on me for almost everything. I'm not sure why that is, because she's perfectly able to do most everything for herself. I wish she would understand that the longer she's able to take care of herself, the longer I'll be able to keep her with me. The more dependent she gets and the more demanding her care gets, I'll have to consider a nursing home where someone can be there 24/7 for her. I just don't want that to happen.

My dad is with my mom, but had to move into an assisted living apartment so she could get more care and allow him the ability to leave her to run errands, etc., without worrying about her. I wish we would have started pureeing her food sooner, but she felt she was doing okay. She was taken to the hospital because she couldn't move for dad and had fallen. It was at a rehab facility that she actually was seen by a geriatric specialist and he told them that one of the meds she was taking for her PD had a anorexic side effect (she had dropped to 82 lbs). He changed her meds and suggested the pureed food and thickened fluids and my mom came back to life. She was starving to death and her doctors at Group Health weren't giving them any practical advice and put her on a med that was tanking her appetite. So this simple change in my mom's care really helped her immensely. We don't want mom to go into a nursing home either, dad doesn't want to be separated from her. My hope is that God will have mercy on my mom and that the end stages of PD would be skipped right over and something else will cause her to pass on. I hope your mom will be able to take more steps for greater self-care. Again, God bless you!!

My dad is with my mom, but had to move into an assisted living apartment so she could get more care and allow him the ability to leave her to run errands, etc., without worrying about her. I wish we would have started pureeing her food sooner, but she felt she was doing okay. She was taken to the hospital because she couldn't move for dad and had fallen. It was at a rehab facility that she actually was seen by a geriatric specialist and he told them that one of the meds she was taking for her PD had a anorexic side effect (she had dropped to 82 lbs). He changed her meds and suggested the pureed food and thickened fluids and my mom came back to life. She was starving to death and her doctors at Group Health weren't giving them any practical advice and put her on a med that was tanking her appetite. So this simple change in my mom's care really helped her immensely. We don't want mom to go into a nursing home either, dad doesn't want to be separated from her. My hope is that God will have mercy on my mom and that the end stages of PD would be skipped right over and something else will cause her to pass on. I hope your mom will be able to take more steps for greater self-care. Again, God bless you!!

Gail, it sounds as if your mother is afraid and/or possibly depressed. Learning new tasks is especially difficult with both advancing age and the inroads PD can make into cognitive skills. In your mother's case, I think that the fall/break made her feel especially vulnerable.

Adult daycare sounds as if it would be an ideal plan if you can find a good one, preferably with transportation provided. People need social interaction. Your mother needs external motivation. She can probably learn to use the electric wheelchair slowly. Perhaps daycare would provide that motivation and assistance not to mention the chance to learn or relearn skills from staff and other attendees.

We all are aware of the risks of postural instability and of freezing with PD. Does your mother get dizzy when she rises either from bed or from a chair? If so she may have Orthostatic Hypotension, possibly medication induced and also treatable...sometimes.

Has she fallen with the walker? Is the walker a heavier one with handbrakes, basket and seat?

How is the incontinence being treated? Is she using disposable underwear? I know these don't often hold enough liquid so you might consider adding a pad. What do her doctors suggest? Has she seen a urologist who understands that this is not just a simple aging process but also a symptom of PD. If she also has urinary retention, that needs to be disclosed as well as this can also lead to infection.

Whatever you you do, don't let her lower her fluid intake. You can however reduce her caffeine and soda intake as long as you substitute.

What does your mother do during the day? It sounds as if she has kind of turned off as a result of the fall. Keep expanding your search area for a facility that will enable you to have a life and still have your mother live at home. (I know this is easy for me to say as there are many such groups in our area and that might not be the case in yours.)

For swallowing issues - here they seem to be caused more by post nasal drip than by PD (my husband who has PD is just beginning to appreciate the difference) but I still make sure that meat is served finely cut up. I enjoy using the food processor to make a chicken/turkey salad or croquette for easier eating. Salads are also cut into smaller bits (no more tearing) and in general, crunch now comes from crackers.

Your mother's PD seems to be progressing slowly. Have you considered medical massage? Exercise therapy or yoga suitable for her physical condition. Joining a class/group can be very stimulating for any PD patient and is especially important for the more elderly.

Best Wishes in finding a center she can attend. I think her motivation level might increase as will her self dependence. You are certainly on the right track.

Addendum: Gail, I'm sorry not to have provided a link to a review and DVD you can purchase to assist your mother with breathing, swallowing and voice issues caused by Parkinson's disease. They are an excellent alternative for those who do not live near a facility with a Speech Pathologist specializing in recovery from stroke and neurodegenerative conditions or for people whose health insurance does not cover this type of therapy. They are also a wonderful way to do exercises at home in a comfortable environment.
http://parkinsonsfocustoday.blogspot.com/2009/05/voice-exercises-will-help-parkinsons.html[blogspot.com]

It is especially important of speech, swallowing and breathing as these can be life threatening in the long run and improve quality of life in the short term. Choking is a serious threat and these and other exercises can help in reducing the risk.

Gail, it sounds as if your mother is afraid and/or possibly depressed. Learning new tasks is especially difficult with both advancing age and the inroads PD can make into cognitive skills. In your mother's case, I think that the fall/break made her feel especially vulnerable.

Adult daycare sounds as if it would be an ideal plan if you can find a good one, preferably with transportation provided. People need social interaction. Your mother needs external motivation. She can probably learn to use the electric wheelchair slowly. Perhaps daycare would provide that motivation and assistance not to mention the chance to learn or relearn skills from staff and other attendees.

We all are aware of the risks of postural instability and of freezing with PD. Does your mother get dizzy when she rises either from bed or from a chair? If so she may have Orthostatic Hypotension, possibly medication induced and also treatable...sometimes.

Has she fallen with the walker? Is the walker a heavier one with handbrakes, basket and seat?

How is the incontinence being treated? Is she using disposable underwear? I know these don't often hold enough liquid so you might consider adding a pad. What do her doctors suggest? Has she seen a urologist who understands that this is not just a simple aging process but also a symptom of PD. If she also has urinary retention, that needs to be disclosed as well as this can also lead to infection.

Whatever you you do, don't let her lower her fluid intake. You can however reduce her caffeine and soda intake as long as you substitute.

What does your mother do during the day? It sounds as if she has kind of turned off as a result of the fall. Keep expanding your search area for a facility that will enable you to have a life and still have your mother live at home. (I know this is easy for me to say as there are many such groups in our area and that might not be the case in yours.)

For swallowing issues - here they seem to be caused more by post nasal drip than by PD (my husband who has PD is just beginning to appreciate the difference) but I still make sure that meat is served finely cut up. I enjoy using the food processor to make a chicken/turkey salad or croquette for easier eating. Salads are also cut into smaller bits (no more tearing) and in general, crunch now comes from crackers.

Your mother's PD seems to be progressing slowly. Have you considered medical massage? Exercise therapy or yoga suitable for her physical condition. Joining a class/group can be very stimulating for any PD patient and is especially important for the more elderly.

Best Wishes in finding a center she can attend. I think her motivation level might increase as will her self dependence. You are certainly on the right track.

Addendum: Gail, I'm sorry not to have provided a link to a review and DVD you can purchase to assist your mother with breathing, swallowing and voice issues caused by Parkinson's disease. They are an excellent alternative for those who do not live near a facility with a Speech Pathologist specializing in recovery from stroke and neurodegenerative conditions or for people whose health insurance does not cover this type of therapy. They are also a wonderful way to do exercises at home in a comfortable environment.
http://parkinsonsfocustoday.blogspot.com/2009/05/voice-exercises-will-help-parkinsons.html[blogspot.com]

It is especially important of speech, swallowing and breathing as these can be life threatening in the long run and improve quality of life in the short term. Choking is a serious threat and these and other exercises can help in reducing the risk.

Thanks for the replies! It's so helpful to hear other people's ideas and thoughts!!

Mom does sometimes get dizzy when she gets up. It's not a huge problem now as she usually just stands there with her walker for a sec to get her bearings. She does use a walker with the handbrakes, seat and basket. Seems like everytime she falls, she falls straight back onto her butt and usually tries to catch herself with her hands (thus the broken arm). She never seems to fall forward so that the walker would help her. It's always straight back.

Her incontinence isn't really being treated that I know of. She doesn't ever had UTI's, but she always wets through her depends at night. I haven't tried adding a pad to them, but that's definitely a good idea. I did try rubber underpants with them, but they didn't help at all. It leaked through the elastic on the legs.

Mom doesn't do anything during the day. I've tried giving her jigsaw puzzles, cards and things like that, but she shows no interest. She has a hearing problem and trouble seeing, so TV isn't really any good for her although she does keep it on most of the day. But sometimes I find her watching cartoons or music videos and not really knowing what she's watching. Seems like she spends most of her day sitting around trying to find things for me to do. She has a mother-in-law suite with her own phone line, so our little system is that she'll ring my phone one time and that's my signal to go down there to see what she needs. Usually it's something like "can you open an Ensure for me" or "can you give the dog some water" or "are you going to wash my clothes today" or "can you take my trash out". Whatever it is, it's definitely not anything that has to be done right that minute, but she feels like it has to be. Instead of having me do a few things at one time, she stretches them out and calls me numerous times throughout the day. It can be very frustrating. I know she's doing it to have someone to talk to or just for a little social interaction. It's just hard to not get frustrated when I see her name on my Caller ID. Having four brothers, you'd think they would help, but they don't. They get frustrated with her not being able to hear them on the phone, so they don't call very often. They all hate the urine smell in her house (that I guess I've gotten immuned to) and use that as an excuse. I'm done with them.

The post nasal drip you mentioned that your husband has is interesting. Mom has a CONSTANT runny nose. It's like a water faucet! It drips clear stuff all day long. There's never a time when I'm talking to her that there's not a drop hanging from her nose. Not very attractive, but she can't help it. I'm not sure if there's a medicine she's taking that causes that or not. I mentioned it to her doctor once and he gave her nose spray to use, but she won't use it.

I've never though of medical massage. We did do speech and physical therapy for a while. If I can get her in the daycare program, they actually will take over all of her medical care including therapies. It's run by a hospital and is an at-home alternative in place of a nursing home. They do provide the transportation (thank goodness) and also take you to any outside specialist that you need to see who's not in their program. It's a great thing, but with Medicare the co-pay is $2400/month. She qualifies for nursing home Medicaid, and with Medicaid there's no charge. So I'm in the process now of getting all the necessary paperwork needed for the Medicaid application. They only register on the first of the month, so it'll probably be February before I can get her in the program.

Thanks again for all of the useful information!! We can all use every bit we can get! Take care!

Thanks for the replies! It's so helpful to hear other people's ideas and thoughts!!

Mom does sometimes get dizzy when she gets up. It's not a huge problem now as she usually just stands there with her walker for a sec to get her bearings. She does use a walker with the handbrakes, seat and basket. Seems like everytime she falls, she falls straight back onto her butt and usually tries to catch herself with her hands (thus the broken arm). She never seems to fall forward so that the walker would help her. It's always straight back.

Her incontinence isn't really being treated that I know of. She doesn't ever had UTI's, but she always wets through her depends at night. I haven't tried adding a pad to them, but that's definitely a good idea. I did try rubber underpants with them, but they didn't help at all. It leaked through the elastic on the legs.

Mom doesn't do anything during the day. I've tried giving her jigsaw puzzles, cards and things like that, but she shows no interest. She has a hearing problem and trouble seeing, so TV isn't really any good for her although she does keep it on most of the day. But sometimes I find her watching cartoons or music videos and not really knowing what she's watching. Seems like she spends most of her day sitting around trying to find things for me to do. She has a mother-in-law suite with her own phone line, so our little system is that she'll ring my phone one time and that's my signal to go down there to see what she needs. Usually it's something like "can you open an Ensure for me" or "can you give the dog some water" or "are you going to wash my clothes today" or "can you take my trash out". Whatever it is, it's definitely not anything that has to be done right that minute, but she feels like it has to be. Instead of having me do a few things at one time, she stretches them out and calls me numerous times throughout the day. It can be very frustrating. I know she's doing it to have someone to talk to or just for a little social interaction. It's just hard to not get frustrated when I see her name on my Caller ID. Having four brothers, you'd think they would help, but they don't. They get frustrated with her not being able to hear them on the phone, so they don't call very often. They all hate the urine smell in her house (that I guess I've gotten immuned to) and use that as an excuse. I'm done with them.

The post nasal drip you mentioned that your husband has is interesting. Mom has a CONSTANT runny nose. It's like a water faucet! It drips clear stuff all day long. There's never a time when I'm talking to her that there's not a drop hanging from her nose. Not very attractive, but she can't help it. I'm not sure if there's a medicine she's taking that causes that or not. I mentioned it to her doctor once and he gave her nose spray to use, but she won't use it.

I've never though of medical massage. We did do speech and physical therapy for a while. If I can get her in the daycare program, they actually will take over all of her medical care including therapies. It's run by a hospital and is an at-home alternative in place of a nursing home. They do provide the transportation (thank goodness) and also take you to any outside specialist that you need to see who's not in their program. It's a great thing, but with Medicare the co-pay is $2400/month. She qualifies for nursing home Medicaid, and with Medicaid there's no charge. So I'm in the process now of getting all the necessary paperwork needed for the Medicaid application. They only register on the first of the month, so it'll probably be February before I can get her in the program.

Thanks again for all of the useful information!! We can all use every bit we can get! Take care!

My husband has PD Dx in the late 80's and he did good for along time the last yr. It all stared when at pharmacy, they change his RX. SAID IT WAS THE SAME MED. soon as i noticed it, I call it to his DR'a attention .They fixed it but he has lost a lot of weight,.He dont talk to much now. So I was wondering if you do not mind sending me a message at my email marielowe56@hotmail.com, the name of the medication,so that I can further investigate what is going on with
my husband.

My husband has PD Dx in the late 80's and he did good for along time the last yr. It all stared when at pharmacy, they change his RX. SAID IT WAS THE SAME MED. soon as i noticed it, I call it to his DR'a attention .They fixed it but he has lost a lot of weight,.He dont talk to much now. So I was wondering if you do not mind sending me a message at my email marielowe56@hotmail.com, the name of the medication,so that I can further investigate what is going on with
my husband.

I bought a small food chopper (looks like a mini food processor) that worked well to grind meats. Because Mama had dentures she had problems with chewing meats. I think using dentures takes a lot of muscle control and she lost the ability to manipulate her jaws to properly chew. The grinding works well. It doesn't puree so the meat is still recognizable.

I bought a small food chopper (looks like a mini food processor) that worked well to grind meats. Because Mama had dentures she had problems with chewing meats. I think using dentures takes a lot of muscle control and she lost the ability to manipulate her jaws to properly chew. The grinding works well. It doesn't puree so the meat is still recognizable.

Hi Gail,
My husband has had PD for 13 years now, he was diagnosed at age 33 so we live with it on SO many levels. He's still young enough to be very active and alert and have strong opinions and desires to do many things while his body doesn't allow for a whole lot of that to happen. You mentioned that your mom depends on you for a lot of things you did for her while she had her cast but no longer has it and is still dependent. Here's a tidbit my husband shared with me as to why he relies on me sometimes to do things I know he can do.
You know those spaz attacks a finger, the corner of your eye or a muscle in your arm can get? Well he says imagine your whole body doing that all day, every day. He says yes, they can do things that people see as effortless. However, every movement is a battle of wills against those spazzy moments and sometimes when you've realized that others may be willing to do the little things, it's easier to just surrender and save your 'fight' for the bigger things like trying to make it to the restroom before you mess yourself.

Hi Gail,
My husband has had PD for 13 years now, he was diagnosed at age 33 so we live with it on SO many levels. He's still young enough to be very active and alert and have strong opinions and desires to do many things while his body doesn't allow for a whole lot of that to happen. You mentioned that your mom depends on you for a lot of things you did for her while she had her cast but no longer has it and is still dependent. Here's a tidbit my husband shared with me as to why he relies on me sometimes to do things I know he can do.
You know those spaz attacks a finger, the corner of your eye or a muscle in your arm can get? Well he says imagine your whole body doing that all day, every day. He says yes, they can do things that people see as effortless. However, every movement is a battle of wills against those spazzy moments and sometimes when you've realized that others may be willing to do the little things, it's easier to just surrender and save your 'fight' for the bigger things like trying to make it to the restroom before you mess yourself.

Thanks for your information . My husband is older, but was in top shape before he had a stroke and then was diagnosed with PD. Knowing that your husband has had this for several years helps me keep things in perspective. I wish you both well. Sending a HUG

Thanks for your information . My husband is older, but was in top shape before he had a stroke and then was diagnosed with PD. Knowing that your husband has had this for several years helps me keep things in perspective. I wish you both well. Sending a HUG

Robertat, While your fears are very real, by voicing them you have given yourself the oportunity to plan your journey. Not only can you make plans for the eventualities, you can even pack you bags knowing that you can always remove and add items along the way.

If you are strong as an ox, your first goal will be to maintain through exercises of all types. Strength training, balance (best in Yoga and aqua-therapy and bicycling) flexibility and range of motion (Yoga or exercise equipment) Dance (the rhythm and the happy endorphin release is wonderful therapy for everyone, your husband included).

If you live near an exercise therapy center, have your doctor prescribe the membership so that you can benefit from health insurance. Some centers even offer medical massage therapy. Find out if they have equipment for Forced Exercise. You sound like the perfect candidate. I happen to feel that there is wonderful potential in Forced Exercise to reduce motor symptoms and reduce medication reliance. In the article linked below are several links to Dr Alberts' videos.

You will be proactive with your doctor(s) in discussion progression of medications so that you will have the symptomatic relief you need but not the layer upon layer of medications which can cause adverse side effects.

If you take a good look at your current diet, you might find that you simply can't eat enough of certain important vitamins and anti-oxidants. Consider the best nutritional supplements. You may not see a difference but sometimes in a progressive condition such as PD, that is actually a good thing.

Exercise coupled with creatine may be far more helpful than realized. Clinical trials are still in progress to determine if this supplement can actually slow progression. I recently switched my husband's creatine and we think that his left arm swing after many years of no arm swing is attributable to this particular product.

Take a look at retirement communities in your area or perhaps the area where you planned for retirement. Look at facilities which offer assisted living as well as more intense nursing care. If that is not in your budget, talk frankly about your options.

You know the symptoms you have now and there are ways to prepare both your home and your support team (Family, friends, medical people) to assist you.

When you have overcome your shock and have begun to breathe again, do the things that you and your husband enjoy. Laugh and smile together because there are bonds here that can never be severed.

Remember that what you have read in this discussion is about people dummping their responsibility onto one family member because they can neither face nor accept reality. Face it now, write it down (consult an attorneywho specializes in these geriatric concerns) and then get on with your life.

As a caregiver I can tell you that there are little triumphs. I am neither as gentle nor sweet as my husband would like (but that's another story), however I rejoice in little things. The restored arm swing was enormous.

Time to sign off, my husband has awakened from a catnap and is hungry. We have to watch the weight loss.

My best wishes to you. Your soulmate will be there for you just as you are there for him.

Robertat, While your fears are very real, by voicing them you have given yourself the oportunity to plan your journey. Not only can you make plans for the eventualities, you can even pack you bags knowing that you can always remove and add items along the way.

If you are strong as an ox, your first goal will be to maintain through exercises of all types. Strength training, balance (best in Yoga and aqua-therapy and bicycling) flexibility and range of motion (Yoga or exercise equipment) Dance (the rhythm and the happy endorphin release is wonderful therapy for everyone, your husband included).

If you live near an exercise therapy center, have your doctor prescribe the membership so that you can benefit from health insurance. Some centers even offer medical massage therapy. Find out if they have equipment for Forced Exercise. You sound like the perfect candidate. I happen to feel that there is wonderful potential in Forced Exercise to reduce motor symptoms and reduce medication reliance. In the article linked below are several links to Dr Alberts' videos.

You will be proactive with your doctor(s) in discussion progression of medications so that you will have the symptomatic relief you need but not the layer upon layer of medications which can cause adverse side effects.

If you take a good look at your current diet, you might find that you simply can't eat enough of certain important vitamins and anti-oxidants. Consider the best nutritional supplements. You may not see a difference but sometimes in a progressive condition such as PD, that is actually a good thing.

Exercise coupled with creatine may be far more helpful than realized. Clinical trials are still in progress to determine if this supplement can actually slow progression. I recently switched my husband's creatine and we think that his left arm swing after many years of no arm swing is attributable to this particular product.

Take a look at retirement communities in your area or perhaps the area where you planned for retirement. Look at facilities which offer assisted living as well as more intense nursing care. If that is not in your budget, talk frankly about your options.

You know the symptoms you have now and there are ways to prepare both your home and your support team (Family, friends, medical people) to assist you.

When you have overcome your shock and have begun to breathe again, do the things that you and your husband enjoy. Laugh and smile together because there are bonds here that can never be severed.

Remember that what you have read in this discussion is about people dummping their responsibility onto one family member because they can neither face nor accept reality. Face it now, write it down (consult an attorneywho specializes in these geriatric concerns) and then get on with your life.

As a caregiver I can tell you that there are little triumphs. I am neither as gentle nor sweet as my husband would like (but that's another story), however I rejoice in little things. The restored arm swing was enormous.

Time to sign off, my husband has awakened from a catnap and is hungry. We have to watch the weight loss.

My best wishes to you. Your soulmate will be there for you just as you are there for him.

Have you ever heard of Dr. A. V. Constantini, MD with the World Health Organization? You might look him up online. He talks about many diseases and I think one of them is Parkinson's. His methods are unconventional yet many of them worked to reverse my mother's emphysema. My mother's doctors said it was impossible to reverse this disease and with their drugs it is yet Dr. Constantini helped a lot and got me on a different regimen for my mother that ended up reversing her emphysema and COPD completely.

Gail,

Have you ever heard of Dr. A. V. Constantini, MD with the World Health Organization? You might look him up online. He talks about many diseases and I think one of them is Parkinson's. His methods are unconventional yet many of them worked to reverse my mother's emphysema. My mother's doctors said it was impossible to reverse this disease and with their drugs it is yet Dr. Constantini helped a lot and got me on a different regimen for my mother that ended up reversing her emphysema and COPD completely.

Actually, Dr Constantini listed several diseases but PD does not appear to have been one of them. HOWEVER, in looking at mycotoxins, which is Dr Constantini's area of interest, it is possible that mycotoxins are an unexplored environmental trigger of PD.

Mycotoxins appear to act in the body in a similar manner to heavy metals and pesticides/herbicides. As such they may consttute an unexplored area of PD.

Mr Miller, you raise a very interesting question. The first being, should PwPs (people with Parkinson's) be tested for yeast and other fungal infection? There are some very lengthy treatments which do not appear to involve pharmaceuticals.

At first I thought your response was in the wrong discussion but your point is well taken. If there is a treatable cause, would the medical condition abate, reverse itself and thereby remove the other issues?

I think that in Gail's family, the problems go deeper as her mother is no of an age when she may need to live with her daughter with or without PD. The question is, would she need nearly as much personal care? And could she stay with her sons for extended visits while Gail and her family have some time to call their own?

Actually, Dr Constantini listed several diseases but PD does not appear to have been one of them. HOWEVER, in looking at mycotoxins, which is Dr Constantini's area of interest, it is possible that mycotoxins are an unexplored environmental trigger of PD.

Mycotoxins appear to act in the body in a similar manner to heavy metals and pesticides/herbicides. As such they may consttute an unexplored area of PD.

Mr Miller, you raise a very interesting question. The first being, should PwPs (people with Parkinson's) be tested for yeast and other fungal infection? There are some very lengthy treatments which do not appear to involve pharmaceuticals.

At first I thought your response was in the wrong discussion but your point is well taken. If there is a treatable cause, would the medical condition abate, reverse itself and thereby remove the other issues?

I think that in Gail's family, the problems go deeper as her mother is no of an age when she may need to live with her daughter with or without PD. The question is, would she need nearly as much personal care? And could she stay with her sons for extended visits while Gail and her family have some time to call their own?

I believe if you look further into Fungalbionics you will probably see the PD information. I know he mentions it in a list at the beginning of his Hope at Last series one on breast cancer and one on prostate cancer. I have not researched PD and do not remember exactly where I saw his references to PD as potentially having a fungal connection.

There are some doctors breaking away from the conventional medicine and the medical protocols such as Dr. Lynn Jennings, MD in Wichita Falls, TX. She might be of help with PD.

Needing a break from 24/7 care giving seems to be a recurring theme. I remember trying to get my family to help when I was taking care of my mother with emphysema. One sister helped for 5 days in two years, the other sister would not be bothered and my only brother helped for 3 half days in the same two year period. It is too bad families do not realize what the caregivers go through every day.

I believe if you look further into Fungalbionics you will probably see the PD information. I know he mentions it in a list at the beginning of his Hope at Last series one on breast cancer and one on prostate cancer. I have not researched PD and do not remember exactly where I saw his references to PD as potentially having a fungal connection.

There are some doctors breaking away from the conventional medicine and the medical protocols such as Dr. Lynn Jennings, MD in Wichita Falls, TX. She might be of help with PD.

Needing a break from 24/7 care giving seems to be a recurring theme. I remember trying to get my family to help when I was taking care of my mother with emphysema. One sister helped for 5 days in two years, the other sister would not be bothered and my only brother helped for 3 half days in the same two year period. It is too bad families do not realize what the caregivers go through every day.

I think that many siblings do realize at least part of the time, energy, emotional expense and sacrifice that their caregiver brothers or sister experience and that is why they do not get involved. But to assuage their guilt, they minimize the cost to the caregiver. The old "best defense is a good offensive." And I know that we all agree that Gail's brothers were fairly offensive as were family members of other responders.

I did find an intro link to the Fungalbionics book series written by A.V. Costantini, Lars I. Qvick & Heinrich Wieland I do not see PD but that doesn't mean there isn't a link.http://www.fungalbionicbookseries.com/fungi-my.htm[fungalbionicbookseries.com]

I think that many siblings do realize at least part of the time, energy, emotional expense and sacrifice that their caregiver brothers or sister experience and that is why they do not get involved. But to assuage their guilt, they minimize the cost to the caregiver. The old "best defense is a good offensive." And I know that we all agree that Gail's brothers were fairly offensive as were family members of other responders.

I did find an intro link to the Fungalbionics book series written by A.V. Costantini, Lars I. Qvick & Heinrich Wieland I do not see PD but that doesn't mean there isn't a link.http://www.fungalbionicbookseries.com/fungi-my.htm[fungalbionicbookseries.com]

I think I saw it in the intro to "Hope at Last: Breast Cancer." I believe he only mentions PD as one of the diseases he believes has a fungal component. The main point is, of course, if conventional medicine is not offering solutions look elsewhere and WHO and A. V. Constantini are certainly good places to start.

I think I saw it in the intro to "Hope at Last: Breast Cancer." I believe he only mentions PD as one of the diseases he believes has a fungal component. The main point is, of course, if conventional medicine is not offering solutions look elsewhere and WHO and A. V. Constantini are certainly good places to start.

I really appreciate as a care giver of my 98 yr. old father all the different possibilities that I can pursue. the one thing not mentioned is why do they start taking off their clothes and depends and pull down their tops all the time?
My dad has upper dentures and always takes them out at the table, and always says there's large amount of food in his bottom teeth that he can't get out. there is nothing in his teeth, but I have him brush them anyhow. I believe what he feels is swollen gums around his teeth. He does get alot of Urinary track infections and is put on Cipro for 10 days and it goes away. He does soak his bed alot lately even if he has a diaper and a pad under him. I started putting on fitted diapers at night instead of the belted ones he can handle. I am hoping when his infection is gone, he will wet less. The day care thing is a great idea and I am trying to get him qualified for Medicaid, but it's a slow process. Gail 1001 we live in Pittsburgh PA and there is a place called Life PGH where they only accept Medicaid and do everything that you mentioned, but there's no coverage from Medicare and a co-pay. The best advice hindesight is make sure all properties and bank accounts are out of your loved ones name because no one can afford the high price of caregiving/nursing homes. Apply for Medicaid as soon as possible for them and there will be an easier transition. If you need the help to get you thru the Golden Years, why can't the system let you have things you need to survive without loosing everything you worked for all your life.
My dad is in the hospital every 3 -4 months with Aspiration Pneumonia, but he's still pushing on. They give him IV antibiotics and it clears up and then therapy and back on to the same old things. He's very upset living this way and tells me and my husband he wishes we wouldn't have to do it all, but he has no one else. My older sister 67 doesn't even come and sit with him everyday. Very annoying and upsetting. I keep telling him that we Love him and as long as we can take care of him, he's staying with us. I do hope God takes him before we can't take care of him anymore as Nursing Homes are so understaffed and non personable. I do not want to see him in one and we promised him we would not put him in one as long as we could take care of him and with God's help we have been doing that for 5 yrs + now. God Bless all the Care Givers and especially their Loved Ones :)

I really appreciate as a care giver of my 98 yr. old father all the different possibilities that I can pursue. the one thing not mentioned is why do they start taking off their clothes and depends and pull down their tops all the time?
My dad has upper dentures and always takes them out at the table, and always says there's large amount of food in his bottom teeth that he can't get out. there is nothing in his teeth, but I have him brush them anyhow. I believe what he feels is swollen gums around his teeth. He does get alot of Urinary track infections and is put on Cipro for 10 days and it goes away. He does soak his bed alot lately even if he has a diaper and a pad under him. I started putting on fitted diapers at night instead of the belted ones he can handle. I am hoping when his infection is gone, he will wet less. The day care thing is a great idea and I am trying to get him qualified for Medicaid, but it's a slow process. Gail 1001 we live in Pittsburgh PA and there is a place called Life PGH where they only accept Medicaid and do everything that you mentioned, but there's no coverage from Medicare and a co-pay. The best advice hindesight is make sure all properties and bank accounts are out of your loved ones name because no one can afford the high price of caregiving/nursing homes. Apply for Medicaid as soon as possible for them and there will be an easier transition. If you need the help to get you thru the Golden Years, why can't the system let you have things you need to survive without loosing everything you worked for all your life.
My dad is in the hospital every 3 -4 months with Aspiration Pneumonia, but he's still pushing on. They give him IV antibiotics and it clears up and then therapy and back on to the same old things. He's very upset living this way and tells me and my husband he wishes we wouldn't have to do it all, but he has no one else. My older sister 67 doesn't even come and sit with him everyday. Very annoying and upsetting. I keep telling him that we Love him and as long as we can take care of him, he's staying with us. I do hope God takes him before we can't take care of him anymore as Nursing Homes are so understaffed and non personable. I do not want to see him in one and we promised him we would not put him in one as long as we could take care of him and with God's help we have been doing that for 5 yrs + now. God Bless all the Care Givers and especially their Loved Ones :)

I started this discussion five months ago and wow, what awesome responses from everybody!

Since then a lot has happened. I had gotten her approved for Medicaid and she was to begin an adult daycare program on March 1st which would have been incredible. They had CNA's who would come in the morning and bathe and dress her, get her breakfast and ready for the daycare van to come by at 7:30. Then she would spend the day there and they would drop her off around 5:15. All of her medical care would have been inclusive at the facility. She would receive OT, PT and speech therapy five days a week.

Then on February 26th she fell while getting herself out of bed. All of her weight landed on her right elbow and she ended up shattering her upper arm. She went by ambulance to the hospital that morning and had surgery the following day which involved 3 plates and numerous pins. During the surgery, there was some damage done to a nerve. So while the outcome on the arm itself was amazing, she no longer can lift her hand at the wrist. It's like her hand is tucked under. The doctors have said this is common and will most likely come back, but it could take up to a year.

Since she was hospitalized on the day she was to begin daycare, they could no longer accept her and the application process would have to be started all over again. That was pretty much a mute point though, because after seh was released from the hospital, we moved her to a rehab facility. She's been there since March 8th. Today they released her from therapy as she has plateaud (sp?) and there's nothing else they can do. She can no longer dress herself, tend to her daily living and since she's a severe fall risk, she's been put in a wheelchair. We moved her from the rehab section of the facility to the long term nursing home section. It's broken my heart, but there's no way I could physically take care of her in the way she needs now.

I've been visiting her at least every other day. When they moved her today, she went from a private rehab room to a semi-private long term care room. It's definitely going to be an adjustment. I brought several pictures, her bedspread and little trinkets from home to try to make it as familiar as possible, but it is what it is and I know she knows that.

My brothers have really shown their true colors over the past 3 months. Two have stepped up (and by that I mean they visit her once a week) and the other 2 are still the same. I've given up trying to get them to visit. They are the ones who will have to live with themselves when/if something happens to her. If that time comes, I'll have the peace of knowing that I did everything in my power to help her and to take care of her. There will be no regrets for me.

All of you who are caregivers, you get my heartfelt prayers. It IS the hardest job you will ever do, but you do it out of love. Leaving my mom each time I visit is so difficult. She cries and makes me tell her exactly when I'll be back. I love her so much, but the change in my life has been a drastic one. I knew I was stifled when she was living with me, but I had no idea how much. I can breathe again. Little things like running to the store without having to call everybody to get someone to sit with her is just amazing. The guilt of having her in a nursing home is overwhelming, but I am comforted by knowing that she is in a nice place and is being well taken care of. I can't look back. I have to let go and let God. Bless everybody!!

I started this discussion five months ago and wow, what awesome responses from everybody!

Since then a lot has happened. I had gotten her approved for Medicaid and she was to begin an adult daycare program on March 1st which would have been incredible. They had CNA's who would come in the morning and bathe and dress her, get her breakfast and ready for the daycare van to come by at 7:30. Then she would spend the day there and they would drop her off around 5:15. All of her medical care would have been inclusive at the facility. She would receive OT, PT and speech therapy five days a week.

Then on February 26th she fell while getting herself out of bed. All of her weight landed on her right elbow and she ended up shattering her upper arm. She went by ambulance to the hospital that morning and had surgery the following day which involved 3 plates and numerous pins. During the surgery, there was some damage done to a nerve. So while the outcome on the arm itself was amazing, she no longer can lift her hand at the wrist. It's like her hand is tucked under. The doctors have said this is common and will most likely come back, but it could take up to a year.

Since she was hospitalized on the day she was to begin daycare, they could no longer accept her and the application process would have to be started all over again. That was pretty much a mute point though, because after seh was released from the hospital, we moved her to a rehab facility. She's been there since March 8th. Today they released her from therapy as she has plateaud (sp?) and there's nothing else they can do. She can no longer dress herself, tend to her daily living and since she's a severe fall risk, she's been put in a wheelchair. We moved her from the rehab section of the facility to the long term nursing home section. It's broken my heart, but there's no way I could physically take care of her in the way she needs now.

I've been visiting her at least every other day. When they moved her today, she went from a private rehab room to a semi-private long term care room. It's definitely going to be an adjustment. I brought several pictures, her bedspread and little trinkets from home to try to make it as familiar as possible, but it is what it is and I know she knows that.

My brothers have really shown their true colors over the past 3 months. Two have stepped up (and by that I mean they visit her once a week) and the other 2 are still the same. I've given up trying to get them to visit. They are the ones who will have to live with themselves when/if something happens to her. If that time comes, I'll have the peace of knowing that I did everything in my power to help her and to take care of her. There will be no regrets for me.

All of you who are caregivers, you get my heartfelt prayers. It IS the hardest job you will ever do, but you do it out of love. Leaving my mom each time I visit is so difficult. She cries and makes me tell her exactly when I'll be back. I love her so much, but the change in my life has been a drastic one. I knew I was stifled when she was living with me, but I had no idea how much. I can breathe again. Little things like running to the store without having to call everybody to get someone to sit with her is just amazing. The guilt of having her in a nursing home is overwhelming, but I am comforted by knowing that she is in a nice place and is being well taken care of. I can't look back. I have to let go and let God. Bless everybody!!

Gail, please forgive yourself. Sometimes there are no options that are acceptable. In this case you found the best nursing care for her. Had she returned to your home sooner or later one or both of you would have been injured during her daily routine...and then who would have cared for her.

The pity is the two reluctant brothers. It is not as if you haven't asked. Your mother is quite aware - cognition in tact - which is wonderful.

Will the nursing home allow photos on the wall? I doubt it but perhaps with those removable picture hanging hooks which leave no mark on the wall. My guess is that your mother appreciates the family photos you already provided. An album is problematic because of her hand but perhaps it would be good therapy.

You made the only possible choice and you are to be commended for your ability to do so. Just because you have some freedom is no reason to feel any guilt. I'll bet that when you were a child your mother's hopes for you included the fact that you would always have some personal freedom and would not have to be her caregiver. So share your day with her and you can both enjoy that freedom.

You are truly remarkable.

Gail, please forgive yourself. Sometimes there are no options that are acceptable. In this case you found the best nursing care for her. Had she returned to your home sooner or later one or both of you would have been injured during her daily routine...and then who would have cared for her.

The pity is the two reluctant brothers. It is not as if you haven't asked. Your mother is quite aware - cognition in tact - which is wonderful.

Will the nursing home allow photos on the wall? I doubt it but perhaps with those removable picture hanging hooks which leave no mark on the wall. My guess is that your mother appreciates the family photos you already provided. An album is problematic because of her hand but perhaps it would be good therapy.

You made the only possible choice and you are to be commended for your ability to do so. Just because you have some freedom is no reason to feel any guilt. I'll bet that when you were a child your mother's hopes for you included the fact that you would always have some personal freedom and would not have to be her caregiver. So share your day with her and you can both enjoy that freedom.

Gail, my heart aches for you. Mama was in assisted living then when the falls were an almost daily occurance, they recommended she be moved to a skilled nursing facility. I had been the child (just me and a sister) who visited once or twice weekly and fetched the things she needed. I took her out for ice cream and for a chance to see something other than those four walls. Because there is no skilled nursing facility near my home, she was moved to one near my sister's home. Sister complained daily about how inconvenient it was to go daily and feed Mama. She could no longer feed herself and the staff was so poor, she was getting very little nutrition or attention. They would put her in a wheel chair and leave her there all day. Then I was unexpectedly offered a early retirement from my job. I felt the stars and moon had aligned....destiny. I took the retirement and brought Mama to live with me. Then sister called daily to tell me how worried she was about me. I assured her I would let her know if I became overwhelmed. I honestly, never felt I had taken on more than I could do and was prepared to be the caregiver for as long as I was needed. Unfortunately, Mama lived with me just six months then passed away from aspiration pneumonia in December of 2010. I can look back now and see that I was indeed confined but my head was in the zone and no way would I confess defeat. I have so much peace knowing I was there when needed and provided the care Mama would have lovingly given either of us. Caregving is a huge task and it is not to be entered into lightly, but when you look at the rewards vs. the sacrifice, I believe you'll find it worthwhile. Good luck. -

Gail, my heart aches for you. Mama was in assisted living then when the falls were an almost daily occurance, they recommended she be moved to a skilled nursing facility. I had been the child (just me and a sister) who visited once or twice weekly and fetched the things she needed. I took her out for ice cream and for a chance to see something other than those four walls. Because there is no skilled nursing facility near my home, she was moved to one near my sister's home. Sister complained daily about how inconvenient it was to go daily and feed Mama. She could no longer feed herself and the staff was so poor, she was getting very little nutrition or attention. They would put her in a wheel chair and leave her there all day. Then I was unexpectedly offered a early retirement from my job. I felt the stars and moon had aligned....destiny. I took the retirement and brought Mama to live with me. Then sister called daily to tell me how worried she was about me. I assured her I would let her know if I became overwhelmed. I honestly, never felt I had taken on more than I could do and was prepared to be the caregiver for as long as I was needed. Unfortunately, Mama lived with me just six months then passed away from aspiration pneumonia in December of 2010. I can look back now and see that I was indeed confined but my head was in the zone and no way would I confess defeat. I have so much peace knowing I was there when needed and provided the care Mama would have lovingly given either of us. Caregving is a huge task and it is not to be entered into lightly, but when you look at the rewards vs. the sacrifice, I believe you'll find it worthwhile. Good luck. -

Gail, your post sounds more like my mom than any I have read. She has PD and pretty advanced dementia. She also has the post nasal drip. She calls it a cold and says she has had it for a month - has been saying that for months. She wears depends at night and I put the biggest Poise pad in the depends. That keeps her from coming through on the bed. I also keep a portable commode beside her bed that she is able to get up and use. She has had numerous falls even though she uses a walker. I have a helper that comes in for three hours in the morning to help with her bath and allow me to get out for a while. I don't think I could survive without that time. I think she needs some contact with others her age, but haven't put her in Adult Day Care. I know she won't want to go. She has an apartment in our basement and I make numerous trips up and down the stairs to keep check on her. She had a hallucination over a year ago and is afraid to sleep downstairs so we put a bed upstairs for her. She is better in the mornings mentally, but that goes downhill during the day. In the evenings she says over and over that she needs to go home. No matter how much I tell her she is home, she doesn't get it. She doesn't know who I am most of the time. Sometimes says I look familiar, but she doesn't know my name. It's so sad to watch.

Gail, your post sounds more like my mom than any I have read. She has PD and pretty advanced dementia. She also has the post nasal drip. She calls it a cold and says she has had it for a month - has been saying that for months. She wears depends at night and I put the biggest Poise pad in the depends. That keeps her from coming through on the bed. I also keep a portable commode beside her bed that she is able to get up and use. She has had numerous falls even though she uses a walker. I have a helper that comes in for three hours in the morning to help with her bath and allow me to get out for a while. I don't think I could survive without that time. I think she needs some contact with others her age, but haven't put her in Adult Day Care. I know she won't want to go. She has an apartment in our basement and I make numerous trips up and down the stairs to keep check on her. She had a hallucination over a year ago and is afraid to sleep downstairs so we put a bed upstairs for her. She is better in the mornings mentally, but that goes downhill during the day. In the evenings she says over and over that she needs to go home. No matter how much I tell her she is home, she doesn't get it. She doesn't know who I am most of the time. Sometimes says I look familiar, but she doesn't know my name. It's so sad to watch.

hi, i'm going through the very same thing right now. Mom is perfectly able to do things on her own, but for some reason, she makes like she can't. I had to leave my home and family to go to her home. I gave it my best shot all summer and now I am having a mini melt down. Last night I ran away, leaving her with my other family members who don't help me at all. I'm guilt ridden and mad. I resent that she can do so many things on her own, but does want to. hands up in the air I am now recovering in a hotel in Bethlehem no less. The family tells me not to worry and they didn't know I was having difficulties. That just isn't true! They live right there! She has started to hallucinate and attack me. I had to leave because I couldn't control my behavior to her. So I left, for her good.

hi, i'm going through the very same thing right now. Mom is perfectly able to do things on her own, but for some reason, she makes like she can't. I had to leave my home and family to go to her home. I gave it my best shot all summer and now I am having a mini melt down. Last night I ran away, leaving her with my other family members who don't help me at all. I'm guilt ridden and mad. I resent that she can do so many things on her own, but does want to. hands up in the air I am now recovering in a hotel in Bethlehem no less. The family tells me not to worry and they didn't know I was having difficulties. That just isn't true! They live right there! She has started to hallucinate and attack me. I had to leave because I couldn't control my behavior to her. So I left, for her good.

I was a charge nurse in a small nursing home for several years. Meats can be ground with a small food mill like you would use for baby's food. Be sure to use something to moisten the meat, like meat juices, soup broth, gravy, etc.

I was a charge nurse in a small nursing home for several years. Meats can be ground with a small food mill like you would use for baby's food. Be sure to use something to moisten the meat, like meat juices, soup broth, gravy, etc.

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